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�, ( 'i c 6�"f <br /> Burnett County Office of Zoning Administrator U - H 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as - c o <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use cs e b <br /> RCD <br /> Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 0 . '-. CI <br /> • <br /> G/ nd,r C. /anke /p — <br /> OWNS (please print) CONTRACTOR or SURVEYOR or AGENT n ^ fD <br /> 22 W6 Sim a cl: <br /> AD SS ADDRESS <br /> AD ESSADDRESS <br /> COO- .) 636, - 7410 V <br /> PHONE PHONE <br /> roq <br /> PLUMBER WELL DRILLER <br /> 0. <br /> ADDRESS ADDRESS c, G) <br /> c') o <br /> ,-» < <br /> 0 <br /> PHONE PHONEz H r <br /> DESCRIPTION 4. Sanitary Facilities: , ° o 0 <br /> 1. Work: 2. New Building Details No. Bathrooms Itl'' o <br /> New Building Tyge of Construction: No. Bedrooms 3 0 4........ <br /> Addition <br /> j—rMe Septic Tank Size Gals. I ZOO : <br /> Sanitary Size ....a6. ft. x ... :-f... ft. <br /> Filling/Grading Height.c,O� Stories ....A- 4a. Absorption Field Site: <br /> Moving Area Soil Type o <br /> Mobile Home Slope 2. <br /> Privy 3. Use (describe exactly family Perc. Rate C----1 ' (A <br /> Wellhome, garage, motel, etc. Dry Well 1 ,s 4- <br /> Subdivision Seepage Trench 42) ----E. <br /> Camping Unit , dA ,C�$ / Privy ^f <br /> 010 .2 <br /> se/nedi t. Seepage Bed .1 <br /> cn <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc.,should be sketched in Fig. A. Include road c- <br /> 0- <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- Q; <br /> section, show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. �a <br /> 5. Lot Size: Fig. A. 6. Location: ' <br /> a�a5 g N <br /> aibn.7 aa./3 Ai✓ <br /> ft. x ft. — sq.ft. f <br /> 4. <br /> N O <br /> 0 1 <br /> N. <br /> A/o. SL o k <br /> A H <br /> 0 <br /> o11.N �" T <br /> z �. <br /> p <br /> Do <br /> cn <br /> U4 <br /> 2S0 ' > el t <br /> g _ g` <br /> m N c'7 c - d <br /> - O1 'c c • <br /> O H. W 0MIZ OO a ' XI <br /> •o EA= a E <br /> b z • -H <br /> G1 DJ <br /> el'iYa44:(1., (466,41/Axa€2) 7'62 '--8 4/ ‘V� 0 <br /> Signature of Owner or Agent Date <br /> SI-Via- ; ,..41 7 93/ 93a.� x MI <br /> Remarks T 0 <br /> rnCD <br /> CD <br /> t _ <br /> II <br /> b « 1, <br /> Inspection Date / . C? o I?, o o cNii m <br /> Zoning Adminis 1tor &" S Ct $ $ $ $ $ $ o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />